There is a nationwide shortage of mental health services, but this shortage is even more pronounced in rural states like North Dakota. In response to the shortage, the state has boosted telemedicine as an option for mental health care.

The ND human services agency has started allowing providers who serve patients through its health centers to live in some of the state’s bigger cities — or even move out of state — and deliver mental health care to rural areas through video calls.

Expanding telemedicine has given North Dakota a way to reach more patients — and convince more psychiatrists to practice in the state. It’s helped them reach more patients in rural areas and those who can’t travel far for mental health care, including the elderly.

“We’ve definitely seen a significant impact on that recruitment and retention,” said Dr. Laura Kroetsch, of the North Dakota human services department. There are 22 psychiatrists who provide telemedicine care through the department’s eight clinics. Another three psychiatrists live out of state and provide telemedicine to those health centers. In December 2018, the department’s psychiatrists provided nearly 500 telemedicine appointments — more than 150 of which were with psychiatrists who live out of state

The state is also trying to prepare the next generation of psychiatrists to provide telemedicine to underserved areas. Once a week, psychiatry residents training at the University of North Dakota treat rural residents across the state by video chat.

Washington state lawmakers have passed two new bills which help expand telehealth services state wide. The first, HB5386, will establish a telemedicine training program covering issues such as licensing, liability, informed consent, and training on how to use technology. Telehealth providers would be required to complete this certification every four years. If signed into law, WA would be the first state to implement and mandate a telemedicine training program.

The second bill, HB5387, would enable healthcare providers using telemedicine to extend the physician’s privileges to the health system in which the patient is located, provided both locations agree to the service.

Both bills were submitted by State Sen. Randi Becker, who said ““This is a first in the nation, this training program that we’re putting in place along with the ease of credentialing for providers providing services through telemedicine. These are phenomenal improvements to our health care system.”

In the single year from 2016 to 2017, telehealth usage as measured by claim lines grew 53 percent – a rate greater than for any of the other venues of care studied.

Telehealth has been growing more rapidly in urban areas than in rural areas. The rural increase in telehealth claim lines from 2012 to 2017 was 482 percent, compared with an increase in urban areas of 1,289 percent. From 2016 to 2017, rural growth was 29 percent and urban growth 55 percent.

In 2017, the top five states for telehealth claim lines as a percentage of all medical claim lines were Oklahoma, Wyoming, Ohio, Hawaii and West Virginia, in order from most to least. None of those states were among the top five in 2016

The bottom five states in 2017 for telehealth claim lines as a percentage of all medical claim lines, in order from least to most, were New Jersey, Rhode Island, Nebraska, Connecticut and South Dakota.

Telehealth was most associated with individuals ages 31 to 60, who accounted for 44 percent of the reimbursement claims in 2017.

Seattle-area startup Clocktree offers a service for patients to find and receive therapy from mental health, relationship, addiction and nutrition counselors. Providers can connect through video and messaging with their patients, and the platform also gives counselors a HIPAA-compliant place to store notes, videos and documents. Read more…